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Background Although specialized trauma care in the triage unit can significantly increase the chances of survival of the injured, the obstacles to rapid triage are still a dilemma. Identifying these barriers is quite essential for effective clinical decision-making and improving positive outcomes. Objective This study aimed to report the experiences of the physicians and nurses regarding the obstacles to rapid triage. Method A qualitative study was performed on twenty physicians and nurses working in the triage unit of Poursina Hospital in northern Iran in 2021 using semi-structured interviews. The experiences were analyzed by the content analysis method. Credibility, reliability, and validity were used for data accuracy and trustworthiness. Sampling continued until data saturation. Results A total of 5 categories and 28 subcategories were obtained including the challenges related to employees, physical resource limitations, disruptions in the processes of triage, controlling and monitoring challenges, and specific characteristics of the referred patients. Conclusion Hospital authorities need to eliminate the barriers to rapid triage of patients which are related to education, experience, training, and retraining of triage staff. Physical resources in these units should increase and the triage processes need to improve by proper leveling of the patients and creating a triage view. The lack of coordination between the pre-hospital emergency team and the triage unit should be improved. Finally, the triage staff can strengthen the therapeutic interaction with agitated patients and caregivers.

مقدمه: در دو دهه اخیر، کمبود تسهیلات یکی از دلایلی بوده که باعث افزایش میانگین زمان تریاژ شده است. این تاخیر باعث طولانی شدن زمان انتظار بیمار شده و احتمال خطاها و مرگ و میر را افزایش می دهد. در مورد نوع تسهیلات مورد نیاز برای یک تریاژ سریع، مطالعه محدود انجام شده است. هدف از مطالعه حاضر تبیین تجارب پزشکان و پرستاران از تسهیلات لازم برای یک تریاژ سریع در مرکز آموزشی- درمانی پورسینای رشت در سال 1400 می باشد. روش کار: این یک مطالعه کیفی با روش تحلیل محتوای قرار دادی بود که روی تجارب بیست نفر در رشته های طب اورژانس، پزشکی عمومی و پرستاری انجام شد. برای استحکام داده ها از چهار معیار گوبا و لینکن استفاده شد. یافته ها: تجارب 20 مشارکت کننده منتج به 4 طبقه و 17 زیر طبقه تحت عناوین ؛ تامین منابع انسانی ، توانمند سازی منابع انسانی، بهبود فرایند تریاژ و تدارک مایحتاج فیزیکی شد. نتیجه گیری: منابع انسانی در تریاژ، مولفه ارزشمندی هستند. براي تحقق رشد و توسعه اين سرمايه ارزشمند، نياز به برنامه ريزي دقيق است. با تامین کارکنان مورد نیاز و ارتقا توانمندی آن ها در بعد آموزش و تجارب می توان سرعت تریاژ را بالا برند. تسریع بخشیدن به فرایند تریاژ با دادن یک درک درست از تریاژ به کارکنان نیز در این راستا موثر است. تامین منابع فیزیکی نیز به عنوان تسهیل کننده شناسایی شده است که باید مسوولین امر دنبال چاره اندیشی در تدارک آن ها باشند.

Purpose As a human right, people need to arrive early at the hospitals when they are injured in traffic accidents. Both the mean and equality of the time of arriving at the hospital are important. This study aimed to investigate inequality in arrival time of emergent traffic accident patients to the hospital in 2018–2019 in a city in the North of Iran. Design/methodology/approach The authors extracted the data from the Guilan province trauma system databank in Poursina Hospital in Rasht in 2018 and 2019. The Gini coefficient was used to calculate inequality, and a regression model was estimated for determining the reason for inequality in time to receive hospital services. Findings The study showed that patients’ arrival time from the time of the accident to the time of arrival to the hospital was 64.48 ± 47.63 min (minimum of 9 min and maximum 462 min). Gini coefficient was 0.31 (p 0.05). Originality/value According to the time of arrival of patients and Gini index, in Rasht, inequality in providing services is not in a bad condition. This indicates that the emergency department does not systematically transport people to the hospital late.

Background: Fairness is an important and controversial issue when allocating public resources. People need to be arrived early to the hospitals when they are injured in traffic accidents. Both the mean and equity of the time of arriving to the hospital are important. The aim of this study was to investigate of equity in arrival time of emergent accidental patient to hospital in 2018-2019 in a city in North of Iran.Methods: This study was a Descriptive-analytical study. In this study we extracted the information from Guilan province trauma system data for Poursina Hospital in Rasht in 2018 and 2019. Data included information on age, sex, level of education, place of residence, time of transfer from the scene of the accident to the hospital, type of vehicle, marriage and occupation. The Gini coefficient was used to calculate equity in access to pre-hospital emergency services and regression models were estimated for inequity in time to receive hospital services. Results: The study showed that the mean and standard deviation of patients' arrival time from the time of the accident to the time of arrival at the hospital was 64.48 ± 47.63 minutes (minimum 9 minutes and maximum 462 minutes). Gini coefficient was 0.31 (p 0.05)Conclusion: According to the time of arrival of patients and Gini index, in Rasht, equity in providing services is in a good condition. This indicates that the emergency department does not systematically transport people to the hospital late.

Introduction: Biochemical markers of myocardial injuries have radical importance in diagnosis or dismissing cardiac events, especially in cases that electrocardiographic findings are not present. Therefore, this study was designed aiming to appraise 1-month outcome of patients presenting to emergency department (ED) following acute coronary syndrome (ACS) with positive creatine kinase-MB (CK-MB) and negative troponin. Methods: This prospective cross-sectional study was done on patients presenting to ED with complaint of acute chest pain and diagnosis of ACS. Patients who did not have a clear electrocardiographic finding indicating acute myocardial infarction (MI) (ST segment elevation) and had positive CK-MB and negative troponin in laboratory tests of serum were included. Demographic data and baseline characteristics, CK serum level, CK-MB, troponin, and 30-day outcome of the patients were analyzed using SPSS version 19. Results: 13759 patients had visited the ED with complaint of chest pain during the study period (57% female). 1003 (7.3%) patients had positive troponin test and 12704 (92.3%) had negative CK-MB index and were therefore eliminated from the study. Finally, 52 (0.4%) had both positive CK-MB and negative troponin indices. 35 (67.3%) of them were discharged from ED after serial electrocardiography and negative troponin test. 11 (21.2%) were admitted to critical care unit but were discharged due to having 2 negative troponin tests in 12 hours and normal serial electrocardiogram. 6 (11.5%) were referred for surgical interventions. No mortality was seen in 1-month follow-up. Conclusion: Based on the results of the present study, only 0.4% of ACS patients presenting to the studied ED had positive CK-MB and negative troponin indices. During 1-month follow-up, no case of mortality or MI was observed among them. Only 2 (3.8%) cases needed surgical intervention.

Introduction: Although vertigo alone is not counted as a disease, it is one of the most common complaints of patients presenting to emergency departments (ED). Considering that in facing peripheral vertigo a single treatment has not been agreed upon, we decided to evaluate the effectiveness and side effects of intravenous (IV) methyl prednisolone and diazepam in treating acute peripheral vertigo in a clinical trial. Methods: This double blind clinical trial was done to compare the effectiveness of IV methyl prednisolone and diazepam in controlling acute peripheral vertigo in patients visiting ED. Patients were allocated to one of the 2 groups using simple randomization, and vertigo severity (based on VAS score), hemodynamic changes, level of consciousness, changes in blood sugar and the side effects were compared between the 2 groups 30, 60, and 120 minutes after injection. Results: The study was done on 113 patients with the mean age of 41.8 ± 10.4 years (20-60) (58.4 male). Patients were divided into 2 groups of IV diazepam (51 patients) and IV methyl prednisolone (62 patients). A significant difference was not found between the 2 groups regarding age (p = 0.83), sex (p = 0.339), vertigo severity (p = 0.337) and vital signs (p = 0.986) on arrival. Vertigo severity only showed significant difference between the groups after 120 minutes of drug administration (p = 0.003). No case of low blood pressure, loss of consciousness, or hemodynamic instability was seen in either group during 120 minutes. Dry mouth was significantly higher in the group receiving IV diazepam (p =0.007). Mean blood sugar for diazepam and methyl prednisolone groups after 60 and 120 minutes were 120.6 ± 36.2 and 143.1 ± 51.2 (p = 0.009) and 119.5 ± 35.1 and 162.9 ± 50.9 (p < 0.001). Conclusion: In conclusion, considering the higher effectiveness and non-significant side effects of IV diazepam, it seems to be better than IV methyl prednisolone for symptom control in patients presenting with acute peripheral vertigo.

Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. Methods: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. Results: 110 infants with the mean age of 14.0 §5.9 months (range: 4–24) and mean weight of 9.7±2 kg (range: 5–15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg /kg groups were 38.2% (21 patients)and 60% (33 patients), respectively (p=0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1±1.1 mg). Conclusion: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg /kg midazolam compared to 0.1 mg /kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects.

Introduction: Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization. Methods: In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient’s head rotation. Result: 114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09. Conclusion: Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results.

Introduction: Traffic accidents are the 8th cause of mortality in different countries and are expected to rise to the 3rd rank by 2020. Based on the Haddon matrix numerous factors such as environment, host, and agent can affect the severity of traffic-related traumas. Therefore, the present study aimed to evaluate the effective factors in severity of these traumas based on Haddon matrix. Methods: In the present 1-month cross-sectional study, all the patients injured in traffic accidents, who were referred to the ED of Imam Khomeini and Golestan Hospitals, Ahvaz, Iran, during March 2013 were evaluated. Based on the Haddon matrix, effective factors in accident occurrence were defined in 3 groups of host, agent, and environment. Demographic data of the patients and data regarding Haddon risk factors were extracted and analyzed using SPSS version 20. Results: 700 injured people with the mean age of 29.66 ± 12.64 years (3-82) were evaluated (92.4% male). Trauma mechanism was car-pedestrian in 308 (44%) of the cases and car-motorcycle in 175 (25%). 610 (87.1%) cases were traffic accidents and 371 (53%) occurred in the time between 2 pm and 8 pm. Violation of speed limit was the most common violation with 570 (81.4%) cases, followed by violation of right-of-way in 57 (8.1%) patients. 59.9% of the severe and critical injuries had occurred on road accidents, while 61.3% of the injuries caused by traffic accidents were mild to moderate (p < 0.001). The most common mechanisms of trauma for critical injuries were rollover (72.5%), motorcycle-pedestrian (23.8%), and car-motorcycle (13.14%) accidents (p < 0.001). Conclusion: Based on the results of the present study, the most important effective factors in severity of traffic accident-related traumas were age over 50, not using safety tools, and undertaking among host-related factors; insufficient environment safety, road accidents and time between 2 pm and 8 pm among environmental factors; and finally, rollover, car-pedestrian, and motorcycle-pedestrian accidents among the agent factors.

Introduction: Previous studies have shown that there is a probability of seizure even with therapeutic doses of tramadol. Yet, no accurate data exist regarding this problem in Iran. Therefore, the present study aimed to evaluate the prevalence of tramadol consumption in patients with first seizure referred to the emergency department (ED). Methods: In the present retrospective one-year cross-sectional study, all patients who were referred to the ED of Poursina Hospital, Rasht, Iran, with the complaint of first seizure were evaluated. Demographic data and data regarding history of tramadol consumption, duration, total dose, last dose, and time passed from the last dose of consumption were recorded and analyzed regarding the study questions using SPSS 20. Results: 383 (68.9%) out of the 556 patients referred to the ED, were experiencing their first seizure (mean age 26.43 ± 6.48 years; 70.5% male). 84 (21.9%) patients had recently used tramadol. History of seizure in the family of tramadol consumers was significantly lower (3.6% compared to 11%; p = 0.036). Mean total tramadol consumption dose in the last 24 hours was 140.17 ± 73.53 mg (range: 50-300 mg). Duration of tramadol consumption was less than 10 days in 84.5% (df: 2; χ2 = 96.1; p < 0.001). In addition, 62 (73.8%) patients had seizure within 6 hours of consumption (df: 3; χ2 = 29.5; p < 0.001). Conclusion: Results of the present study showed that 21.9% of the patients with first seizure had a history of tramadol consumption. Seizure following tramadol consumption is more prevalent in the initial 10 days and within 6 hours of consumption. In addition, it seems that lower doses of tramadol may also induce seizure.

Introduction: Both midazolam and promethazine are recommended to be used as sedatives in many studies but each have some side effects that limits their use. Combination therapy as an alternative method, may decreases these limitations. Therefore, this study aimed to compare midazolam with midazolam-promethazine regarding induction, maintenance, and recovery characteristics following pediatric procedural sedation and analgesia. Methods: Children under 7 years old who needed sedation for being CT scanned were included in this double-blind randomized clinical trial. The patients were randomly divided into 2 groups: one only received midazolam (0.5 mg/kg), while the other group received a combination of midazolam (0.5 mg/kg) and promethazine (1.25 mg/kg). University of Michigan Sedation Scale (UMSS) was used to assess sedation induction. In addition to demographic data, the child’s vital signs were evaluated before prescribing the drugs and after inducing sedation (reaching UMSS level 2). The primary outcomes in the present study were onset of action after administration and duration of the drugs’ effect. Results: 107 patients were included in the study. Mean onset of action was 55.4±20.3 minutes for midazolam and 32.5±11.1 minutes for midazolam-promethazine combination (pConclusion: Based on the findings of this study, it seems that using a combination of midazolam and promethazine not only speeds up the sedation induction, but also decreases unresponsiveness to the treatment and the need for a rescue dose.

Introduction: Hanging is one of the most commonly used way to commit suicide in many countries. This method used in suicide is considered a problem in Iran too, but no clear data exists regarding hanging in different regions or the country as a whole. Because of the epidemiologic differences in non-judicial hanging in different regions, this study aimed to assess it in Gilan province, Iran between 2011 and 2013. Methods: In this cross-sectional study, profiles of hanging cases registered in Poorsina hospital in Gilan, Iran between 2011 and 2013 were evaluated. Age, sex, marital status, place of residency, level of education, occupation, history of suicide, history of clinical illness, season of suicide and hanging outcome were evaluated. Results: 59 cases of hanging (mean age 31.4 ± 13.1 years and 83.0% male) were evaluated. 12 (20.34%) suffered from psychological disorders, and 9 (15.2%) confessed to substance abuse. 7 (11.9%) had a history of suicide attempts by hanging. Hanging was significantly higher in men (pConclusion: The results of this study showed that in 2 years, 59 cases committed suicide by hanging themselves, 33.9% of which finally died. Committing suicide by hanging was significantly more prevalent in men, people with an education level of less than high school diploma and the unemployed.

مقدمه: ترخیص با رضایت شخصی به حالتی گفته می شود که بیمار بطور داوطلبانه قبل از دستور پزشک اقدام به ترک بیمارستان نماید که خود می تواند حاکی از وجود مشکلی در بیمارستان و یا کیفیت خدمات درمانی ارائه شده باشد. این مطالعه به بررسی میزان و علل ترخیص با رضایت شخصی در بخش اورژانس بیمارستان پورسینای رشت پرداخته است. روش کار: مطالعه مقطعی حاضر به بررسی دلایل ترخیص با رضایت شخصی در بخش اورژانس بیمارستان پورسینای رشت پرداخته است. جامعه مورد پژوهش کلیه بیماران ترخیص شده با رضایت شخصی در بازه زمانی فروردین تا اسفند ماه سال 1391 بودند. اطلاعات دموگرافیک و اطلاعات مربوط به وضعیت بیمه، نوع بیمه (تامین اجتماعی، خدمات درمانی، روستایی، کمیته امداد، نیروهای مسلح، ماده 92، بیمه تکمیلی و سایر)، تعداد روزهای بستری، شیفت بستری (صبح، عصر، شب)، نوع بیماری یا علت مراجعه (مولتیپل تروما، جراحی، ارتوپدی، نوروسرجری، نورولوژی)، پذیرش مجدد احتمالی در طی 15 روز آینده و دلایل ترخیص با رضایت شخصی با استفاده از چک لیست از قبل طراحی شده جمع آوری و تکمیل گردید. در نهایت داده ها با استفاده از نرم افزار آماری SPSS نسخه 20 و آزمون آماری مربع کای مورد تجزیه و تحلیل آماری قرار گرفتند. مقادیر P کمتر از 0.05 معنی دار تلقی گردید. يافته ها: در بازه زمانی مورد مطالعه در مجموع 3367 بیمار در بخش اورژانس پذیرش شدند که 1060 (31.4 درصد) بیمار با دادن رضایت شخصی بیمارستان را ترک نمودند (62.92 درصد مذکر). بیشتر افراد ترخیص شده با رضایت شخصی متأهل بوده و سنی بین 20 تا 30 سال داشتند. بیشتر بیماران دارای مشکل نورولوژی و جراحی بوده و زمان مراجعه اکثریت آنها در شیفت عصر و شب بود. 62.17 درصد بیماران دارای بیمه ماده 92 و تأمین اجتماعی بودند. علل ترخیص با رضایت شخصی در 1009 مورد (95.19 درصد) به دلیل مسائل مرتبط با خود بیمار نظیر احساس بهبودی و تمایل به درمان در مراکز خصوصی، در 35 مورد (3.3 درصد) به دلایل مرتبط با کادر درمانی و در 16 مورد (1.51 درصد) مرتبط با وضعیت اقامتی بیمارستان بود. پذیرش مجدد در طی 15 روز پس از ترخیص در 9.06 درصد از بیماران ترخیص شده با میل شخصی مشاهده شد. نتيجه گيری: بر اساس نتایج مطالعه حاضر عمده موارد ترخیص با رضایت شخصی به دلیل مسایل مرتبط با خود بیمار بوده است. افزایش آگاهی بیماران از عوارض احتمالی ترخیص پیش از موعد، طرح ریزی برنامه درمانی سرپایی، ارتقاء سطح کیفیت خدمات پزشکی و درمانی می تواند در کاهش موارد رضایت با تمایل شخصی کمک کننده باشد.

مقدمه: صدمات تروماتیک مغزی یکی از مهمترین علل مرگ و میر و معلولیت هستند. با در نظر گرفتن تناقضات متعدد جهت ترخیص بیماران با ضربه به سر به خصوص صدمات تروماتیک مغزی خفیف، این مطالعه با هدف بررسی اپیدمیولوژیک صدمات تروماتیک مغزی طراحی شده است. روش کار: در این مطالعه مقطعی گذشته نگر، بیماران با ترومای منحصر سر، بدون فاکتورهای مخدوش کننده و همه آنها که تحت سی تی اسکن سر قرار گرفتند، با نمونه گیری در دسترس وارد این مطالعه شدند. اطلاعات دموگرافیک و تشخیص نهایی این بیماران از پرونده های بالینی استخراج و مورد تحلیل آماری با استفاده از نرم افزار SPSS 21 و تست های آماری متناسب قرار گرفت. يافته ها: 786 بیمار با میانگین سنی 8/16 ± 24 سال (دامنه: 75-5/0) مورد بررسی قرار گرفتند (8/67 درصد مرد). 42 بیمار (3/5 درصد) سی تی اسکن مغز غیرطبیعی داشتند و بستری شدند. از بین این 42 بیمار، 7 نفر (7/16 درصد بیماران بستری، 3/3 درصد بیماران کم خطر و 9/0 درصد کل بیماران) در دسته ی کم خطر از جهت احتمال وجود ضایعه مغزی قرار داشتند. 12 نفر (5/1 درصد) از بیماران به عمل جراحی احتیاج داشتند که از این میان 2 نفر (9/0 درصد) از بیمارانی بوده اند که جزو دسته کم خطر طبقه بندی شده بودند. استفراغ در بیماران با اسکن غیرطبیعی (2/45 درصد) به طور معنی داری بیشتر از بیماران با اسکن طبیعی (6/19 درصد) بود (p = 0/001 ). در سایر علائم اختلاف معنی داری بین دو گروه مشاهده نشد. نتيجه گيری: با توجه به یافته های این مطالعه، می توان نتیجه گرفت که با تصمیم گیری بر اساس علائم بالینی صرف احتمال خطا در مدیریت حدود 3/3 درصد بیماران مبتلا به ترومای سر وجود دارد. همچنین حدود 9/0 درصد از بیمارانی که در دسته کم خطر طبقه بندی شدند در نهایت به .عمل جراحی احتیاج پیدا کردند

به خروج سر استخوان هومروس از حفره گلنویید استخوان اسکاپولا دررفتگی شانه اطلاق میگردد که 50 درصد کل دررفتگی های مفاصل بزرگ را به خود اختصاص داده است. با توجه به اهمیت عوارض و ناتوانی های ایجاد شده در اثر این نوع دررفتگی و در عین حال قابل پیشگیری بودن آن، مطالعه حاضر با هدف بررسی ویژگی های اپیدمیولوژیک بیماران مبتلا به دررفتگی شانه طراحی شد. در یک مطالعه مقطعی گذشته نگر، تمامی بیماران مراجعه کننده به بخش اورژانس با شکایت دررفتگی شانه طی یک سال مورد بررسی قرار گرفتند. اطلاعات دموگرافیک و ویژگی های مربوط به نوع دررفتگی، وجود شکستگی همراه، مکانیسم ایجاد دررفتگی، سابقه قبلی دررفتگی و روش جااندازی مورد استفاده از پرونده بالینی بیماران استخراج و در چک لیست طراحی شده به همین منظور ثبت گردید. داده ها بعد از ثبت و جمع آوری، توسط نرم افزار آماری SPSS نسخه 19 مورد تجزیه و تحلیل آماری قرار گرفت. بر این اساس، 120 بیمار با میانگین سنی 21/2 ± 39/3 سال در بخش اورژانس مرکز مورد مطالعه طی یک سال پذیرش شده بودند (2/79 درصد مرد). بیشترین نوع دررفتگی از نوع قدامی (95/8 درصد) و در سمت راست اتفاق افتاده بود (52/5 درصد) و شایعترین علت دررفتگی، افتادن روی دست باز عنوان شده بود (34/2 درصد). جااندازی در 39/3 درصد موارد به روش بسته و در 6/7 درصد به روش جراحی صورت گرفته بود. بر اساس نتایج حاضر در جمعیت مورد مطالعه اکثر بیماران مبتلا به دررفتگی شانه مردان جوانی بودند که به دنبال افتادن روی دست باز دچار دررفتگی قدامی شانه سمت راست شده بودند و با استفاده از روش بسته تحت سدیشن وریدی مورد جااندازی قرار گرفته بودند.

Shoulder dislocation is identified as displacement of humerus head from the glenoid cavity of scapula bone, which makes up about 50% of total joint dislocations. Taking into account the importance of the side effects and disabilities caused by this type of dislocation and that it can be prevented, the present study was designed aiming to evaluate the epidemiologic characteristics of the patients with shoulder dislocation. In this retrospective cross-sectional study, all the patients referred to the emergency department (ED) with complaint of shoulder dislocation throughout one year were evaluated. Demographic data and characteristics regarding the type of dislocation, presence of accompanying fractures, mechanism of dislocation, history of dislocation and the method of reduction were extracted from the patients’ profiles and recorded in a checklist designed for this purpose. Data were then statistically analyzed using SPSS version 19. Statistics showed that 120 patients with the mean age of 39.3 ± 21.2 years had been admitted to ED of the studied center in one year (79.2% male). The most common type of dislocation was anterior dislocation (95.8%) and in the right shoulder (52.5%) and the most common cause was falling on open arm (34.2%). Reduction method was non-operative in 93.3% of the cases and surgery in 6.7%. Based on the results of this study, in the studied population, most patients with shoulder dislocation were young men who had an anterior dislocation in their right shoulder because of falling on out stretched hand and treated with close reduction.

مقدمه: سالمندان دیابتیک به دلیل بیماری های زمینه ای یا ناتوانی های جسمی مستعد ایجاد تروما هستند، در این مطالعه بر آن شدیم به بررسی همه گیر شناسی تروما در بیماران سالمند دیابتی مراجعه کننده به بخش اورژانس بیمارستان پورسینای شهر رشت در سال 1390 بپردازیم. روش کار: این مطالعه به صورت مقطعی بر روی پرونده تمامی سالمندان دیابتی بالای 60 سال مراجعه کننده به بخش اورژانس بیمارستان پورسینای شهر رشت، استان گیلان انجام گرفت. اطلاعات دموگرافیک و اطلاعات مربوط ویژگی های تروما از قبیل: نوع، فصل ایجاد، تعداد روز های بستری، مکان ایجاد، محل آناتومیک، مرگ ومیر، خون مورد نیاز و زمان پذیرش تا فوت برای تمام بیماران از طریق چک لیست از قبل طراحی شده جمع آوری و ثبت گردید. در نهایت فاکتورهای موثر در مرگ و میر مورد ارزیابی قرار گرفت. داده ها با استفاده از نرم افزار آماري SPSS نسخه 21 و به كارگیري آزمون هاي مربع كاي مورد تجزیه و تحلیل قرار گرفتند. 05/0>p به عنوان سطح معنا داری در نظر گرفته شد. يافته ها: 268 بیمار ترومایی مبتلا به دیابت با میانگین سنی 18/7±94/69 سال بررسی شدند (6/58 درصد زن). بیشترین مکانیسم تروما؛ سقوط در سطح همتراز (3/40 درصد)، بیشترین مکان ایجاد تروما؛ خیابان های درون شهری و سایر اماکن ( 8/35 درصد)، بیشترین مکان آناتومیک تروما؛ اندام ها (6/45 درصد)، بیشترین فصل ایجاد تروما؛ زمستان (28 درصد) بود. 2/14 درصد از بیماران نیاز به تزریق خون داشتند و در کل 3/6 درصد از بیماران فوت نمودند. میانگین روز های بستری در بخش 14/5±72/3 (بین 6 ساعت تا 53 روز) بدست آمد. نتایج آنالیز رگرسیون چند متغیره حاکی از ارتباط معنی دار جنس (012/0p=)، مکان آناتومیک تروما (047/0p=)، تعداد محل های آناتومیک (030/0p=)، نیاز به تزریق خون (001/0> p)، فشار خون سیستولیک زیر 90 میلی متر جیوه (017/0p=)و تعداد ضربان قلب بالای 100 بار در دقیقه (001/0> p) و مرگ و میر ناشی از تروما در سالمندان دیابتی بود. نتيجه گيری: یافته های پژوهش حاضر حاکی از آن است که بیشترین مکانیسم تروما سقوط در سطح همتراز، بیشترین مکان ایجاد تروما خیابان ها و سایر اماکن درون شهری، بیشترین مکان آناتومیک ایجاد تروما اندام ها و بیشترین فصل ایجاد تروما زمستان بود. بین مرگ و میر سالمندان دیابتی مراجعه کننده به اورژانس با جنسیت، مکان آناتومیک تروما، تعداد محل آناتومیک آسیب دیده، نیاز به تزریق خون، فشار خون سیستولیک زیر 90 میلی متر جیوه و تعداد ضربان قلب بالای 100 بار در دقیقه ارتباط معناداری دیده شد.

مقدمه: تروما از مهمترین عوامل مرگ و میر در بیماران زیر 40 سال و سومین علت شایع مرگ بدون در نظر گرفتن سن می باشد. از علل مهم مرگ در دقایق اولیه پس تروما، آسیب های قفسه سینه می باشند. لذا مطالعه حاضر به منظور بررسی فراوانی آسیب ارگان های داخل شکمی در بیماران با شکستگی دنده مراجعه کننده به بیمارستان پورسینای رشت در سال 1390 انجام شده است. روش کار: این مطالعه به صورت مقطعی (Cross-Sectional) و بر روی 60 بیمار با شکستگی دنده که از اول فروردین ماه تا 29 اسفند 1390 در بخش اورژانس بیمارستان پورسینای رشت بستری شده بودند انجام شد. برای تمامی افراد مورد پژوهش چک لیستی شامل سن، جنس، مکانیسم تروما (سرنشین اتومبیل، عابر، موتورسوار، سقوط و سایر)، سمت شکستگی دنده (راست، چپ، دو طرفه)، سطح شکستگی دنده (فوقانی یعنی دنده ی 1 و2، میانی یعنی دنده ی 3 تا 8 و تحتانی یعنی دنده ی 9 تا 12)، تعداد دنده های شکسته شده، نتیجه ی سونوگرافی شکمی (که توسط متخصص رادیولوژی در بخش اورژانس صورت می گیرد)، انجام یا عدم انجام لاپاراتومی و مرگ و میر تکمیل گردید. اطلاعات جمع آوری شده با استفاده از روش های آمار توصیفی دسته بندی و با نرم افزار SPSS 16 مورد آناليز قرار گرفتند. يافته ها: 60 بیمار با میانگین سنی 13/71 ± 47/26 سال طی این مدت به اورژانس مرکز مورد مطالعه مراجعه کرده بودند (81/7 درصد مرد). در میان بررسی های انجام شده شایع ترین مکانیسم تروما، تصادف با اتومبیل با 22 مورد (36/7 درصد) بود. در میان 60 بیمار مورد مطالعه 71 مورد شکستگی دنده در 3 سطح ( فوقانی، میانی، و تحتانی) تشخیص داده شد و شکستگی در50 (83/3 درصد) مورد در یک سطح بود. میانگین تعداد دنده های شکسته برابر با 2/2 ± 2/85 بود (کمترین 1 و بیشترین 10). شکستگی در 3 بیمار (5 درصد) دوطرفه بود. نتیجه سونوگرافی شکمی تنها در 7 (11/7 درصد) بیمار مثبت گزارش گردید. ارتباط آماری معنی دار بین تعداد دنده های شکسته (0/017=p) و محل شکستگی (0/048=p) با وجود مایع آزاد داخل شکمی بر اساس نتایج سونوگرافی وجود دارد. شکستگی بیش از 2 دنده ارتباط مستقیمی با احتمال بروز خونریزی داخل شکمی داشته است (0/0001>P). نتيجه گيری: بر اساس نتایج مطالعه حاضر به نظر می رسد ارتباط مستقیم و معنی داری بین تعداد و محل شکستگی دنده با احتمال بروز آسیب احشاء شکمی بر اساس نتایج سونوگرافی وجود داشته باشد.

Introduction: Elderly diabetic patients are prone to trauma due to background illnesses or physical disabilities. In the present epidemiologic study, we aimed to evaluate pattern of trauma in elderly diabetic patients referred to the emergency department of Poorsina Hospital, Rasht, Iran, 2011. Methods: This cross-sectional study was performed on the diabetic patients over 60 years old. Demographic data, trauma characteristics, mortality, need for blood transfusion, and the time interval between admission and death, were gathered. Finally, the risk factors of the mortality were evaluated. PResults: 268 patients with mean age of 69.94±7.18 years were evaluated (58.6% female). Most common trauma mechanism was same level falling (40.3%); most common location for trauma was urban streets (35.8%); most common anatomic site were extremities (45.6%); and the season with highest trauma occurrence was winter (28%). 14.2% of the patients needed blood transfusion and 6.3% of the patients finally died. Mean hospitalization duration in the department was 3.72±5.14 days (between 6 hours to 53 days). There was a significant correlation between mortality of the elderly diabetic patients and sex (p=0.012), anatomic site of trauma (p=0.047), number of injured site (p=0.030), need for blood transfusion (p100/minute (pConclusion: The results of this study, show that the most common trauma mechanism was same level falling, the most common site of trauma was streets and other places in the city, most common anatomic site for trauma were extremities; the season with highest trauma occurrence was winter. There was a significant correlation between mortality of patients and sex , anatomic site of trauma, number of injured site, need for blood transfusion , systolic blood pressure < 90 mmHg and heart rate >100/minute.

Introduction: Discharge against medical advice (AMA) is the patient voluntarily leaving the hospital against the physician’s advice, which might indicate a problem in the hospital or the quality of care in it. This study aimed to evaluate the frequency and reasons of AMA in the emergency department (ED). Methods: The present cross-sectional study evaluated the reasons of AMA in the ED of Poursina Hospital, Rasht, Iran. The studied population included all the discharged AMA patients from April 2012 to March 2013. Demographic data and data regarding insurance status, insurance provider, number of hospitalization days, admission shift (morning, evening, night), type of disease or reason for referral (multiple trauma, surgery, orthopedics, neurosurgery, neurology), probable readmission in the next 15 days, and reasons for discharge AMA were gathered using a pre-designed checklist. Data were analyzed using SPSS version 20 and chi square test. p < 0.05 was considered significant. Results: 3367 patients were admitted to ED over the course of the study, 1060 (31.4%) of which were discharged AMA (62.92% male). Most discharged AMA patients were married and 20-30 years old. Most had neurological problems and surgery, and were referred in the evening or night shifts. 62.17% of the patients were insured by Ta’min Ejtema’i insurance company. The reasons for discharge AMA was patient related in 1009 (95.19%) cases, medical staff related in 35 cases (3.3%), and hospitalization related in 16 (1.51%) cases. Readmission in the next 15 days was seen in 9.06% of those who were discharged AMA. Conclusion: Based on the results of the present study, most cases of discharge AMA were patient related. Increasing the knowledge of the patients regarding probable consequences, designing outpatient management programs for these patients and improving the quality of medical services can help decrease discharge AMA cases.

Introduction: Traumatic brain injuries are among the most important causes of mortality and disability. Since there is a lot of controversy regarding discharge of head trauma patients, especially those with mild traumatic brain injuries, this study was designed aiming to evaluate traumatic brain injuries from an epidemiologic point of view. Methods: In this retrospective cross-sectional study, patients with isolated head trauma, and all those who underwent computed tomography (CT) were included using convenience sampling. Demographic data and final diagnosis of the patients were extracted from their medical profile, and were analyzed using SPSS 21 and appropriate statistical tests. Results: 786 patients with the mean age of 24 ± 16.8 years (range: 0.5 – 75) were evaluated (67.8% male). 42 patients (5.3%) had abnormal CT scan and were hospitalized. 7 of them (16.7% of hospitalized, 3.3% of low-risk, and 0.9% of all patients) were in the group categorized as low-risk regarding probability of brain injuries. 12 (1.5%) participants needed surgery, 2 of which (0.9%) were initially categorized as low-risk. Vomiting was significantly more in patients with abnormal CT scan (45.2%) compared to those who had normal CT scan (19.6%) (p = 0.0001). No significant difference was detected between the 2 groups in other symptoms. Conclusion: The results of this study indicate that by making decisions based on clinical findings alone, there is a probability of about 3.3% error in management of head trauma patients. In addition, 0.9% of the patients initially categorized as low-risk, needed surgical intervention in the end.

Introduction: Trauma is one of the most important causes of death in patients under 40 years of age and the third common cause of death regardless of age. Rib cage damages are one of the major reasons for death in the early minutes post-trauma. Therefore, the present study aimed to evaluate the frequency of intra-abdominal injury in the patients with rib fracture who were referred to emergency department. Methods: This cross-sectional study included 60 patients with rib fractures who were admitted to the emergency department of Poorsina Hospital, Rasht, Iran, from March 2011 to March2012. A checklist was filled out for all the patients including age, sex, trauma mechanism, side and site of fracture, the number of broken ribs, the results of abdominal ultrasonography, the need for laparotomy and mortality. The collected data were classified based on descriptive statistics and analyzed using SPSS 16. Results: 60 patients with the mean age of 47.26±13.71 years were admitted to the emergency department during this time (81.7% male). The most common mechanism of trauma was car accident [22(36.7%]. Among these 60 patients, 71 rib fractures in 3 levels of chest (upper, middle, lower) were detected and 50 (83.3%) in the same area. Mean number of fractured ribs was 2.85±2.2 (minimum: 1, maximum 10). In 3 (5%) patients, fracture was on both sides. The results of abdominal ultrasonography in 7 (11.7%) patients were positive. The number of fractured ribs (p=0.017) and the area of the fracture (p=0.048) showed a significant correlation with the presence of intra-abdominal free fluid. The fracture of more than 2 ribs directly correlated with the possibility of intra-abdominal hemorrhage (pConclusion: Based on the results of this study, it seems that the number and area of the fractured ribs directly and significantly correlate with the probability of abdominal trauma based on the results of abdominal ultrasonography.

Introduction: Animal bite because of following killing infections such as Rabies is considered as one of the health problem issues in Iran and other countries. Although extensive progressions have been achieved in prevention and treatment areas, spread of animal bite still has an increasing rate and large amount of costs have been annually spent to provide vaccine and anti-bodies. This study was done with the aim of epidemiologic evaluation of animal bite in Rasht county, Guilan province, Iran, 2012. Methods: In a prospective cross- sectional study, the related data of whole animal bite cases were gathered in terms of demographic information (age, sex, and occupation), animal species, animal dependency (wild, domesticated, unknown), habitant, part of body bitten, season, and type of wound. Results: Totally 1014 cases (72.5%) of animal bite were reported. The mean age of studied population was 33.63±17.81 years. The most cases of animal bite were related to dog (79.2%), domestic animals (88.3%), village habitants (61.3%), hand (55.2%), spring season (29.8%), and superficial type of wound (64.3%). The patients bitten from the face area were younger than those injured in other sites (p=0.001). The bitten individuals by other animals were younger than people bitten by cat or dog (p=0.002). Conclusion: The results of the present study showed that the incidence of animal bite was higher in spring season, by domestic dogs, among men in rural area, and as superficial wounds in the 20-29 age group. The animal bite has a relation with gender, age, and habitant. Animal bite has been yet considered as one of the public health problems and training activities could have a significant role to control such cases.

Introduction: Emergency department (ED) as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran. Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001). The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001). Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001). The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002). Also, during 2005-2008 the hospitalization mean of the patient has remarkably decreased from 1.08±0.44 days to 0.35±0.05 days in 2009-2012 (p=0.021). The occupied bed mean before and after the presence of emergency medicine specialists were 12173±3453 and 6217±219, respectively, showed a descending trend into the past (p=0.018). Conclusion: It seems that presenting of emergency medicine specialists in health system leads to improve the service delivery to patients and decrease the waiting time. Also with decreasing the waiting time of patients and timely disposition, more prepared beds can be accessible in the ED for future admission.

مقدمه: حیوان گزیدگی همچنان به عنوان یکی از معضلات مهم بهداشتی در ایران و سایر کشورهای جهان مطرح است. علیرغم پیشرفت های گسترده ای که در امر پیشگیری و درمان حاصل شده است، موارد حیوان گزیدگی هنوز از روند رو به رشدی برخوردار است. طبق برآوردهای سازمان بهداشت جهانی سالانه بیش از ده میلیون نفر در مناطق مختلف دنیا به دنبال گزیدگی، تحت درمان قرار می گیرند. با توجه به اهمیت عوارض ایجاد شده توسط حیوان گزیدگی و در عین حال قابل پیشگیری بودن آنها در این مطالعه بر آن شدیم تا به بررسی اپیدمیولوژی موارد حیوان گزیدگی در شهرستان رشت در سال 1391 بپردازیم. روش کار: این مطالعه به صورت گذشته نگر و مقطعی می باشد. داده های مرتبط با کلیه موارد حیوان گزیدگی در شهرستان رشت در سال 1391 بر اساس اطلاعات موجود در دفاتر ثبت موارد حیوان گزیدگی شهرستان جمع آوری گردید. برای تمامی بیماران چک لیستی شامل سن، جنس، شغل، نوع حیوان، وضعیت حیوان، محل سکونت، عضو گاز گرفته شده، فصل گزش و نوع زخم تکمیل گردید. يافته ها: در مجموع 1014 مورد حیوان گزیدگی گزارش گردید (72/5 درصد مرد). میانگین سنی افراد مورد مطالعه 17/81±33/63 سال بود. بیشترین موارد حیوان گزیدگی مربوط به سگ (79/2درصد)، حیوانات اهلی (88/3) و در محیط های روستایی (61/3 درصد) بود. بیشترین عضو گزیده شده دست (55/2 درصد)، بیشرین فصل بروز حادثه بهار (29/8 درصد) و بیشترین نوع زخم از نوع سطحی (64/3 درصد) بود. افرادی که از ناحیه سر و صورت دچار گزش شده اند به طور معنا داری کم سن تر از افرادی بودندکه از ناحیه دست یا پا دچار آسیب شده بودند (0/001=p). همچنین افرادی که توسط سایر حیوانات به جزء سگ و گربه دچار گزش شده بودند به طور معنی داری کم سن تر بودند (0/002=p). نتيجه گيری: بر اساس نتایج مطالعه حاضر بیشتر موارد حیوان گزیدگی در شهرستان رشت استان گلستان در فصل بهار، توسط سگ های اهلی، در مردان روستایی، بصورت سطحی و در گروه سنی 20 تا 29 اتفاق می افتد. فراوانی حیوان گزیدگی با جنس، سن و محل سکونت ارتباط داشته و هنوز یکی از مشکلات مهم بهداشت عمومی است که فعالیت های آموزشی می تواند نقش به سزایی در کنترل آن داشته باشد.

مقدمه: بخش اورژانس یا فوریت های پزشکی به عنوان قلب بیمارستان به دلیل پذیرایی از متنوع ترین و حساس ترین گروه بیماران از اهمیت ویژه ای برخوردار است. هدف بخش اورژانس ارائه با کیفیت ترین خدمات درحداقل زمان با استفاده از منابع موجود است. به منظور دستیابی به این هدف استقرار متخصصین طب اورژانس که به ارزیابی، احیاء، تثبیت، تشخیص و مراقبت از بیماران اورژانس می پردازد از اهمیت ویژه ای برخوردار است. هدف از این مطالعه بررسی تاثیر استقرار متخصصین این رشته بر نحوه تعیین تکلیف بیماران بخش اورژانس بیمارستان پورسینای رشت می باشد. روش کار: در این مطالعه مقطعی پرونده تمامی بیمارانی که از سالهای 84 الی 91 در بخش اورژانس بیمارستان پورسینای رشت بستری شده بودند، مورد بررسی قرار گرفت و متغییرهایی نظیر سن، جنس، علت مراجعه، تاریخ و تعداد موارد بستری، تعداد موارد ترخیص از بخش، درصد اشغال تخت و تخت روز اشغالی، مدت زمان بستری، تعداد ترخیص زیر 6 ساعت، تعداد موارد انتقال به بخش ها یا بیمارستان های دیگر و میزان گردش تختهای بخش اورژانس مورد بررسی قرار گرفت. اطلاعات از طریق سیستم اطلاعات بیمارستانی جمع آوري شد و با استفاده از نرم افزار آماری SPSS 20 مورد تجزیه و تحلیل قرار گرفت. يافته ها: طی سال های 1384 تا 1391 تعداد ورودی بیماران بستری شده در بخش اورژانس سیر صعودی داشت به طوری که بیشترین تعداد بیماران پذیرش شده مربوط به سال 1391 بود (0/0001= p). آمار بیماران ترخیص شده زیر 6 ساعت و میزان ترخیص مستقیم از اورژانس از 15/5درصد و 58/9 درصد قبل از استقرار متخصصین طب اورژانس به ترتیب به 23/4 درصد و 61/2 درصد بعد از حضور آنها افزایش یافت ( 0/0001 = p). انتقال به بخش ها و بیمارستانهای دیگر نیز از 41/1 درصد و 38/8 درصد کاهش یافت (0/0001 = p). درصد اشغال تخت بعد از حضور متخصصین طب اورژانس نسبت به قبل روند نزولی قابل توجهی داشت، در حالیکه مقدار فعالیت تخت روند صعودی داشت، بدین معنی که در سالهای 1384 تا 1387میانگین فعالیت تخت از 108/4±354/3 به 30/8±637/7 در سالهای 1388 تا 1391رسید (0/002=p). میانگین مدت زمان بستری بیمار نیز از 0/44±1/1 روز به 0/05 ±0/35 روز کاهش یافت (0/021=p). میانگین تخت روز اشغالی قبل از استقرار متخصصین طب اورژانس 3453 ±12173 و بعد از استقرار متخصصین طب اورژانس 219±6217 می باشد که روند نزولی را نسبت به قبل نشان داد (0/018=p). نتيجه گيری: به نظر میرسد که با حضور متخصصین طب اورژانس در سیستم درمانی، خدمت رسانی به بیماران اورژانس وضعیت مطلوب تری پیدا میکند و زمان انتظار برای دسترسی به خدمات کاهش می یابد. در ضمن با کاهش زمان انتظار بیماران و تعیین تکلیف به موقع آنها تخت های بیشتری جهت پذیرش های آینده در دسترس قرار می گیرد.

Introduction: Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization. Methods: In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient’s head rotation. Result: 114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09. Conclusion: Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results.

Colloid cysts are mucous-filled masses with an outer fibrous layer. These cysts are rare developmental malformation and not a true neoplasm. They usually found incidentally and are asymptomatic; but in some cases may associate with rapid neurologic deterioration, herniation, and sudden death. Recognition of this rare but important diagnosis may result in decreasing mortality. In this report, we presented a 13-year-old boy with complaint of two times drop attack and final diagnosis of colloid cyst in the third brain ventricle.

Introduction: Patients' satisfaction (PS) is one of the important indicators of emergency care quality and outcomes of health care services. Some researchers believe that improve the work processes and hospital quality are not possible without caring to comments, requirements, expectations, and satisfaction of patients. The percent study was aimed to assess the emergency department (ED) PS of Poursina hospital, Rasht, Iran. Methods: In this descriptive cross sectional study, the samples was selected from 378 patients admitted to ED of Poursina Hospital, Rasht, Iran, 2013. For each patient a check list and a questionnaire, including 37 questions about PS, were filled that had categories like physical comfort and residential aspects, physicians care, nurse care, behavioral aspect, and waiting time for service presentation. Data were analyzed by SPSS version 16. Results: Entirely, 378 patients were entered to the study with mean age of 38.44±17.8 (60.8% male). The mean score of total satisfaction of ED patients was 106.94±13.62 (range: 72-144). The mean score of physical comfort was 33.25±4.76 out of the highest obtainable score of 55, nurse care 25.33±5.13 out of 40, physician care 24.34±3.38 out of 40, waiting time for services 13.42±5.48 out of 30, and behavioral aspects 10.58±2.66 out of 20. There were significant relation among PS, sex (P=0.0001), and the shift of admission (P=0.023). Conclusion: The findings of percent study showed that giving services to emergency clients in various fields such as physical comfort and residential aspects, physicians care, nurse care, and the total ED satisfaction is relatively agreeable. The periodic and continuous assessment as well as comparison of satisfaction and dissatisfaction parameters during the time, before and after performing the changes, could be effectual.

Introduction: Traumatic brain injuries (TBI) are one of the most important causes of death in patients under the age of 25 years and is responsible for one third of total deaths caused by trauma. Therefore, knowing its epidemiologic pattern in different populations seems vital. Therefore, this study aims to examine the epidemiologic pattern of TBI in emergency department. Methods: In this cross-sectional study, the profiles of 1000 patients affected by TBI were selected using simple random sampling. The examined variables in this study included demographic, season, mechanism of injury, accompanying injuries, level of consciousness, hospitalization duration, computed tomography (CT) scan results, needing surgery, admission to intensive care unit, and outcome of the patient. In the end, independent risk factors for the death of patients were determined. Results: 1000 patients suffering from were studied (81.8% male; mean age 38.5±21.7 years). The frequency of their referral to hospital in spring (31.4%) was more (pConclusion: Age Over 60 years, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and need to be admitted to intensive care unit were independent risk factors for the death in TBI patients.

Introduction: Hanging is one of the most commonly used way to commit suicide in many countries. This method used in suicide is considered a problem in Iran too, but no clear data exists regarding hanging in different regions or the country as a whole. Because of the epidemiologic differences in non-judicial hanging in different regions, this study aimed to assess it in Gilan province, Iran between 2011 and 2013. Methods: In this cross-sectional study, profiles of hanging cases registered in Poorsina hospital in Gilan, Iran between 2011 and 2013 were evaluated. Age, sex, marital status, place of residency, level of education, occupation, history of suicide, history of clinical illness, season of suicide and hanging outcome were evaluated. Results: 59 cases of hanging (mean age 31.4 ± 13.1 years and 83.0% male) were evaluated. 12 (20.34%) suffered from psychological disorders, and 9 (15.2%) confessed to substance abuse. 7 (11.9%) had a history of suicide attempts by hanging. Hanging was significantly higher in men (p

مقدمه: مارکرهای بیوشیمیایی مربوط به آسیب میوکارد به خصوص در مواردی که یافته های الکتروکاردیوگرافیک وجود ندارند، اهمیتی بنیادی در تشخیص یا رد عارضه قلبی دارند. لذا مطالعه حاضر با هدف بررسی پیامد یک ماهه بیماران مراجعه کننده به بخش اورژانس به دنبال سندرم کروناری حاد با کراتین کیناز-ام بی مثبت و تروپنين منفي طراحی شده است. روش کار: این مطالعه مقطعی آینده نگر بر روی بیماران مراجعه کننده به بخش اورژانس با شکایت درد حاد قفسه سینه و تشخیص سندرم کروناری حاد صورت پذیرفته است. بیمارانی که یافته الکتروکاردیوگرافیک واضحی به نفع سکته قلبی حاد نداشتند (بالا رفتن قطعه ST) و از طرفی در بررسی آزمایشگاهی سطح سرمی کراتین کیناز-ام بی مثبت و تروپونین منفی داشتند وارد مطالعه شدند. متغیرهای دموگرافیک و پایه، سطح سرمی کراتین کیناز، کراتین کیناز-ام بی و تروپونین و پیامد 30 روزه بیماران با نرم افزار آماریSPSS نسخه 19 مورد آنالیز قرار گرفتند. یافته ها: 13759 بیمار در طول زمان مطالعه با شکایت درد قفسه سینه به بخش اورژانس مذکور مراجعه کرده بودند (57 درصد زن). 1003 (3/7 درصد) بیمار دارای تست تروپونین مثبت و 12704 (3/92 درصد) مورد اندکس کراتین کیناز-ام بی منفی داشتند و درنتیجه از مطالعه حذف شدند. در نهایت52 (4/0 درصد) نفر اندکس کراتین کیناز-ام بی مثبت و تروپونین منفی داشتند. 35 (3/67 درصد) بیمار با انجام نوار قلب سریال و تست تروپونین منفی از بخش اورژانس ترخیص گردیدند. 11 (2/21 درصد) بیمار در بخش سی سی یو بستری شدند که در فاصله زمانی 12 ساعت دو بار تروپونین منفی و نوار قلبی سریال نرمال داشته و ترخیص شدند.6 (5/11 درصد) بیمار نیز جهت انجام مداخلات جراحی ارجاع شدند. هیچ مورد مورتالیتی در پیگیری یک ماهه مشاهده نگردید. نتیجه گیری: بر اساس نتایج مطالعه حاضر تنها 4/0 درصد از بیماران مبتلا به سندرم کروناری حاد مراجعه کننده به بخش اورژانس مذکور دارای اندکس کراتین کیناز-ام بی مثبت و تروپونین منفی بودند که در بررسی پیامد یک ماهه هیچ موردی از مرگ و میر و سکته قلبی در آنها مشاهده نگردید. تنها 2 (8/3 درصد) مورد نیازمند مداخله جراحی شدند.

مقدمه: اگر چه سرگیجه به تنهایی یک بیماری محسوب نمی شود اما یکی از شایعترین شکایات مراجعین به بخش های اورژانس است. با توجه به اینکه در برخورد با سرگیجه محیطی درمان واحدی مورد اتفاق نظر نیست برآن شدیم که تاثیر و عوارض متیل پردنیزولون و دیازپام وریدی را طی یک کارآزمایی بالینی در درمان سرگیجه حاد محیطی مقایسه نماییم. روش کار: این مطالعه به صورت کارآزمایی بالینی دو سویه کور و با هدف مقایسه اثربخشی متیل پردنیزولون و دیازپام وریدی در کنترل سرگیجه حاد محیطی بر روی بیماران مراجعه کننده به بخش اورژانس انجام شد. بیماران با استفاده از روش تصادفی ساده به یکی از دو گروه مذکور تقسیم شدند و شدت سرگیجه (بر اساس معیار VAS)، تغییرات همودینامیک، سطح هوشیاری، تغییرات قند خون و در نهایت عوارض جانبی بین دو گروه در دقایق 30، 60 و 120 بعد از تزریق مورد مقایسه قرار گرفت. يافته ها: مطالعه بر روی 113 بیمار با میانگین سنی 4/10 ± 8/41 سال (60-20) انجام شد (4/58 مرد). بیماران به دو گروه دیازپام وریدی (تعداد = 51 نفر) و متیل پردنیزولون وریدی (تعداد = 62 نفر) تقسیم شدند. اختلاف معنی داری بین دو گروه از جهت سن (830/0 =p)، جنس (339/0 = p)، شدت سرگیجه (337/0 =p) و علائم حیاتی (986/0 =p) بدو ورود وجود نداشت. شدت سرگیجه تنها در دقیقه 120 بعد از مصرف دو دارو با هم اختلاف معنی داری داشت (003/0 = p). هیچ موردی از افت فشارخون، کاهش سطح هوشیاری و ناپایداری همودینامیک در دو گروه مورد مطالعه طی 120 دقیقه مشاهده نگردید. خشکی دهان در گروه دریافت کننده دیازپام وریدی به طور معنی داری بالاتر بود (007/0 = p). میانگین قند خون گروه دیازپام و متیل پردنیزولون در دقیقه 60 و 120 به ترتیب عبارت بودند از: 2/36 ± 6/120 و 2/51 ± 1/143 (009/0 = p) و 1/35 ± 5/119 و 9/50 ± 9/162 (001/0 > p). نتيجه گيری: به طور کلی شاید بتوان گفت با در نظر گرفتن اثربخشی مناسب تر و کم اهمیت بودن عوارض جانبی مشاهده شده با دیازپام وریدی این دارو انتخاب مناسب تری نسبت به متیل پردنیزولون وریدی در کنترل علامت بیماران مراجعه کننده با سرگیجه حاد محیطی باشد.